Atlanta providers reach deal on indigent dialysis

By KATE BRUMBACK -
Associated Press -
Wednesday, September 7, 2011

ATLANTA (AP) - Atlanta’s safety net hospital on Wednesday reached an agreement with a private dialysis provider to continue treating a group of indigent patients, some of whom became critically ill after their life-sustaining treatment was cut off last week when a previous contract expired.

Grady Memorial Hospital will pay Fresenius Medical Care to treat the nearly two dozen patients, but the details were still being worked out and the amount paid and length of contract were not immediately available, said hospital spokesman Matt Gove. Regular dialysis treatment can resume at Fresenius clinics immediately, said company spokeswoman Jane Kramer.

Most of the patients are illegal immigrants, and their treatment has been in limbo several times since budget cuts forced Grady to close its outpatient dialysis clinic two years ago.

Patients with end-stage renal failure need regular dialysis two or three times a week to survive. After closing its clinic, Grady Memorial Hospital paid for treatment for about three dozen patients at private clinics through the end of last August. Under an agreement reached last year, three private clinics took on 13 patients as charity cases, and Grady agreed to pay Fresenius to treat the remaining patients.

After Grady’s agreement with Fresenius expired Aug. 31, Fresenius turned away patients who arrived for care, telling them to go to Grady. The hospital, which has faced more budget cuts this year, has said it couldn’t continue to shoulder the full cost for regular treatment.

Medicare, the federal health insurance program for people 65 and older, covers routine dialysis for U.S. citizens regardless of their age. But illegal immigrants are ineligible.

Hospitals can get reimbursed by Medicaid, the state-federal program that helps low-income people, when they provide emergency dialysis for illegal immigrants in life-or-death situations. But the reimbursement doesn’t come close to covering what hospitals spend.

Bineet Kaur, one of the patients, was elated when she heard an agreement had been reached.

“That is just such great news. I’m so happy,” she said by phone from Grady, where she was waiting for a heart test. After a week without dialysis, her heartbeat had become irregular and she had trouble breathing, she said.

Kaur came to the U.S. from India on a tourist visa in 2000 and applied for political asylum, saying she didn’t feel safe in her country as a single woman living alone. Her asylum request was denied, making her an illegal immigrant. She was diagnosed with kidney failure in 2003 and told she needed dialysis, but she didn’t get treatment because she had no insurance. After several years of extreme pain, she fainted while driving in early 2009, crashing her car into a pole and eventually ended up getting regular treatment at Grady.

She was among a group of patients turned away from Fresenius last Thursday and from Grady on Saturday. She went back to Grady Tuesday night and was deemed sick enough for emergency treatment. But she was so weak that she had to be hospitalized overnight before dialysis could begin Wednesday morning, she said.

The announcement of an agreement may have come too late for Reina Andrade. The 33-year-old was also turned away from Fresenius last week and from Grady on Saturday. She became so sick Sunday that she passed out and her sister took her to a suburban Atlanta emergency room, where she got treatment. With prospects for future treatment uncertain, she boarded a plane Wednesday morning for her native Honduras, her sister said.

Andrade, who had lived in the U.S. illegally for 11 years, has needed dialysis for the last five years.

Her sister, Marlen, said Wednesday before the agreement was reached that she didn’t know whether Reina would be able to get the regular treatment she needs in Honduras because their mother lives far from a major city.

A doctor who gave her emergency treatment earlier this week told Reina that if she kept waiting to get treatment until she was in critical condition, she could only expect to live for about a year. The sisters and their mother decided that risk wasn’t worth taking. Marlen Andrade did not immediately return a call Wednesday after the agreement had been reached.